| NPI | 1235995317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL ISW19761) |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2024-06-18 |