| NPI | 1669502209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL SW7623) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL sw7623) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2022-04-18 |