| NPI | 1457870040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 104100000X Social Worker |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2021-04-26 |