| NPI | 1720252992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 2323C) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 102L00000X Psychoanalyst | |
| 104100000X Social Worker | |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2012-02-01 |