| NPI | 1912013392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1199) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 05745) |
| 1041C0700X Social Worker, Clinical (Licence: IA 06756) | |
| 1041C0700X Social Worker, Clinical (Licence: NE 1413) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2024-08-22 |