| NPI | 1518362110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 13257-C) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 24250) |
| 1041C0700X Social Worker, Clinical (Licence: TX 24250) | |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2023-08-16 |