| NPI | 1366235053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW009640) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA CSW009640) |
| Enumeration Date | 2025-05-26 |
| Last Update Date | 2025-09-17 |