| NPI | 1336562412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ID 36509) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID 33555) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2021-01-11 |