| NPI | 1881120061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC P013194) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2017-05-07 |
| Last Update Date | 2019-03-07 |