| NPI | 1528331451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health (Licence: UT 9681278-3501) | |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2024-12-02 |