| NPI | 1861682494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 5298-C) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 5430188-3501) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2022-05-21 |