| NPI | 1497263735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MT BBH-LCSW-LIC-25637) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2023-09-29 |