| NPI | 1730190760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MO 000758) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 000758) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2015-03-06 |