| NPI | 1104916428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW0002939) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL SW0002939) |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2015-01-14 |