| NPI | 1891873220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 539) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 1429) |
| 1041C0700X Social Worker, Clinical (Licence: NE 764) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2010-11-10 |