| NPI | 1306139621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 3707) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3181) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2024-06-10 |