| NPI | 1245490069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 2766) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 117983) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2025-08-12 |