| NPI | 1760843676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904003141) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0812000185) |
| Enumeration Date | 2016-03-19 |
| Last Update Date | 2016-04-15 |