| NPI | 1467063370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L11378) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR A5201) |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2025-11-05 |