| NPI | 1487143558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 12302) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC 12302) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2020-12-18 |