| NPI | 1730191644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 407) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW 7539) |
| 101YM0800X Counselor, Mental Health (Licence: NE 1928) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2011-03-16 |