| NPI | 1811062474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 1197-M) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AR 1197-M) |
| 101YM0800X Counselor, Mental Health (Licence: AR 1197-M) | |
| 104100000X Social Worker (Licence: AR 1197-M) | |
| 1041C0700X Social Worker, Clinical (Licence: AR 2162-C) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2011-01-19 |