| NPI | 1356891352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical (Licence: NC C011952) | |
| 1041C0700X Social Worker Clinical (Licence: VA 0904012504) | |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2023-03-06 |