| NPI | 1699871756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 2216-123) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 1283-125) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2014-09-15 |