| NPI | 1841484458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MN 18121) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW 20272) |
| 1041C0700X Social Worker Clinical (Licence: OR 6834) | |
| 1041C0700X Social Worker Clinical (Licence: WA LW60622688) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2018-03-17 |