| NPI | 1801120407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2011-08-29 |