| NPI | 1720319916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 32555) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LMSW-29802) |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2023-06-07 |