| NPI | 1861700676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 107715) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05416100) | |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2022-11-21 |