| NPI | 1639787666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI 5242) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: HI no5242) |
| 101YM0800X Counselor, Mental Health | |
| 101Y00000X Counselor | |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2026-02-25 |