| NPI | 1104356674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC P011681) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P016205) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2022-07-28 |