| NPI | 1649766536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 10108914-3502) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2019-09-30 |