| NPI | 1902813421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C001138) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 3535) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2013-06-11 |