| NPI | 1992048227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 2012030024) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MO 2002032138) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2019-10-28 |