| NPI | 1790084903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 6088162-6009) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 6088162-3503) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2021-08-04 |