| NPI | 1144518382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: IA 007521) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: IA 007521) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2026-05-08 |