| NPI | 1093806887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW12589) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL ISW3192) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2015-07-23 |