| NPI | 1063680650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: IL 149.017451) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: WA LW00009364) | |
| 1041C0700X Social Worker, Clinical (Licence: CA LCS 28549) | |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2022-10-27 |