| NPI | 1447534268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7350613-3501) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 7350613-3501) |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2016-11-28 |