| NPI | 1871740498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MD LC3647) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2018-10-18 |