| NPI | 1932246840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NE 50) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 176) |
| 101YP2500X Counselor Professional (Licence: NE 283) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2015-04-20 |