| NPI | 1235295726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 60164) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY R027465-1) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2022-12-24 |