| NPI | 1023257854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE #675) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NE 675) |
| 1041C0700X Social Worker Clinical (Licence: NE #653) | |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2021-02-22 |