| NPI | 1205289188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW13779) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL SW13779) |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2025-01-09 |