| NPI | 1275957573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 1031456) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 1031456) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2021-11-19 |