| NPI | 1215166731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 787) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 787) |
| 101YP2500X Counselor, Professional (Licence: MO 2007016865) | |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2024-02-09 |