| NPI | 1851698062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NE 807) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 1539) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2011-02-24 |