| NPI | 1023179819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 000893) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 000893) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2022-07-21 |