| NPI | 1568801587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50080419) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DC PRC985) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2023-01-30 |