| NPI | 1699949198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L4909) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LMSW-28510) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2012-06-06 |