| NPI | 1245225994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1252) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 2225) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2025-01-26 |