| NPI | 1609745637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 38562) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MN 34692) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2025-10-29 |
| Last Update Date | 2025-10-29 |