| NPI | 1700968419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MA 1029510) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 1029510) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2010-03-19 |