| NPI | 1285143511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103T00000X Psychologist |
| 101YM0800X Counselor Mental Health | |
| 104100000X Social Worker | |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2017-09-29 |