| NPI | 1760504807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L5115) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR A2934) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2013-04-22 |