| NPI | 1902154396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 174400000X Specialist | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2021-06-21 |