| NPI | 1821661364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P016470) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC P016470) |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2021-07-28 |