| NPI | 1780725259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 260) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC LPC719) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2008-12-09 |