| NPI | 1013946581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 3242) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MO 2003028464) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2023-02-15 |