| NPI | 1609532167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 8861915) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 10382488-3502) |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2025-07-30 |