| NPI | 1750835930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C011764) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC P010819) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2020-01-24 |