| NPI | 1043496680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY KY-1058) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH8993) |
| 1041C0700X Social Worker, Clinical (Licence: FL MH8993) | |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2011-12-14 |