| NPI | 1104983980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 7244) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC C005197) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2017-12-08 |