| NPI | 1578924858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2024-04-16 |