| NPI | 1548457484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 000723) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 001087) |
| 101YP2500X Counselor, Professional (Licence: MO 000723) | |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2007-09-25 |