| NPI | 1790877090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 5935490-6009) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 5935490-3503) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2013-11-21 |