| NPI | 1801005954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR 2056) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR L2056) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2015-01-21 |