| NPI | 1841737210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 317978-3501) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: UT 317978-6101) |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2017-01-24 |