| NPI | 1780948687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C009967) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC P007376) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2023-01-23 |