| NPI | 1467761593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW 9244) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL SW9244) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2022-03-04 |