| NPI | 1982012506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS M6346) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2014-07-28 |