| NPI | 1235475757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: SC 12662) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: FL 12544) |
| 101YP1600X Counselor Pastoral | |
| 1041C0700X Social Worker Clinical (Licence: FL SW15171) | |
| 1041C0700X Social Worker Clinical | |
| 1041S0200X Social Worker School (Licence: FL SW15171) | |
| Enumeration Date | 2013-01-02 |
| Last Update Date | 2022-09-08 |