| NPI | 1871912873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 1594) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 1594) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2018-09-25 |