| NPI | 1861883969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 101Y00000X) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2021-05-30 |