| NPI | 1568501138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 2834) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 2834) |
| 104100000X Social Worker (Licence: LA 2834) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2017-09-25 |