| NPI | 1497164347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW- 36181) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 14206814-3501) |
| 101YM0800X Counselor, Mental Health (Licence: ID LCSW-36181) | |
| 1041C0700X Social Worker, Clinical (Licence: UT 14206814-3501) | |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2025-09-25 |