| NPI | 1588968903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 15721) |
| 1041C0700X Social Worker, Clinical (Licence: NC C015910) | |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2023-06-08 |