| NPI | 1942487004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW12065) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 079962) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2020-12-21 |