| NPI | 1245612464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL U625540534510) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2022-05-04 |