| NPI | 1669640231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 104100000X Social Worker | |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2018-05-30 |