| NPI | 1912214719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: ND 4539) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: ND 4539) | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2024-05-23 |