| NPI | 1578843843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QC1500X Clinic/Center, Community Health | |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2015-01-14 |