| NPI | 1457755217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103T00000X Psychologist |
| 104100000X Social Worker | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2017-06-29 |