| NPI | 1033806724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 103TF0000X Psychologist, Family | |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2023-04-21 |
| Last Update Date | 2023-04-21 |