| NPI | 1336463173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C000055) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC C000055) |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2011-02-15 |