| NPI | 1851546907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C0053) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL 0108C) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2009-12-07 |