| NPI | 1285961433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW60951098) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: NM I-06049) |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2019-09-17 |