| NPI | 1710962246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC C005033) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 965) |
| 1041S0200X Social Worker, School (Licence: NC C005033) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2012-07-09 |