| NPI | 1922352251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL SW12771) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: FL SW12771) | |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2016-07-21 |