| NPI | 1427286277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MS C9578) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 4171) |
| 1041C0700X Social Worker, Clinical (Licence: OK 4171) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2020-06-19 |