| NPI | 1033689682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 14980) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 11840) |
| 1041C0700X Social Worker, Clinical (Licence: SC 11840) | |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2022-02-28 |