| NPI | 1225162902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 206819) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 1585) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2025-09-11 |