| NPI | 1215385034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 121744) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2021-10-13 |