| NPI | 1598162653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C017510) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2025-09-29 |