| NPI | 1376402487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TF0000X Psychologist, Family | |
| 103TS0200X Psychologist, School | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2026-01-15 |
| Last Update Date | 2026-01-15 |