| NPI | 1720428295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC PO15578) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P007860) |
| 1041S0200X Social Worker, School (Licence: NC P007860) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2023-02-07 |