| NPI | 1245486174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW004867) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 44SC04335300) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2013-03-18 |