| NPI | 1376220152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 25643) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PR 4581) |
| 104100000X Social Worker | |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2025-07-24 |