| NPI | 1699978585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 1112) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 7944) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2014-10-10 |