| NPI | 1245431188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 104100000X Social Worker | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2013-03-25 |