| NPI | 1245216837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 002326) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 000226) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2014-08-25 |