| NPI | 1063618114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C001286) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 996) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2025-09-11 |