| NPI | 1043688005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 103T00000X Psychologist | |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2015-09-08 |