| NPI | 1962707950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WI 1000-125) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WI 2221-123) |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2018-05-08 |