| NPI | 1689910200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW15910) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL 2333) |
| Enumeration Date | 2012-12-31 |
| Last Update Date | 2020-06-18 |