| NPI | 1609566009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 4761571) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID 059532) |
| Enumeration Date | 2023-05-09 |
| Last Update Date | 2026-05-06 |