| NPI | 1386919116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 12258) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: FL 12258) | |
| 1041C0700X Social Worker, Clinical (Licence: FL 3615) | |
| 1041S0200X Social Worker, School (Licence: FL 962188) | |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2022-02-28 |