| NPI | 1255524153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904018420) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW04387) |
| 101YM0800X Counselor, Mental Health (Licence: PR 5047) | |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2025-11-17 |