| NPI | 1629966643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2025-06-26 |