| NPI | 1689046039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW17121) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: FL SW17121) | |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2020-03-09 |