| NPI | 1679948921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA cws006196) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC008256) |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2021-01-14 |