| NPI | 1619102183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC-4361) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2009-08-12 |