| NPI | 1992103204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 1025) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2014-12-18 |
| Last Update Date | 2015-04-15 |