| NPI | 1750871810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW15145) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL SW15145) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2019-01-28 |