| NPI | 1871879593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904003110) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0812000377) |
| 1041S0200X Social Worker School (Licence: VA 0904003110) | |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2011-10-26 |