| NPI | 1689055253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C012847) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC P009604) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2022-06-27 |