| NPI | 1720527468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2163) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 11109) |
| 104100000X Social Worker (Licence: NE 1835) | |
| 1041C0700X Social Worker, Clinical (Licence: NE 7139) | |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2020-10-05 |