| NPI | 1750582532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PR 2394) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PR 2394) |
| 1041S0200X Social Worker, School (Licence: PR 2394) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2007-07-08 |