| NPI | 1649717109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2017-01-23 |
| Last Update Date | 2017-01-23 |