| NPI | 1184744666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CT 001459) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 001459) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2012-01-26 |