| NPI | 1790952901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C006014) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC C006014) |
| 101YM0800X Counselor Mental Health (Licence: NC C006014) | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2015-11-20 |