| NPI | 1073094835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD G06690) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD G06690) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2025-08-22 |