| NPI | 1780058339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 080199) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 080199) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2018-03-17 |