| NPI | 1487056693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 1759-123) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 1759-123) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2024-12-12 |