| NPI | 1548976350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 132905121) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2023-01-25 |
| Last Update Date | 2023-09-19 |