| NPI | 1083149058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 14849) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2022-05-09 |