| NPI | 1689789497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK CSWS546) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: AK 106501) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2019-12-06 |