| NPI | 1013334366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL SW7594) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW 7594) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2025-05-22 |