| NPI | 1558143602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO .09929578) |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2024-12-26 |