| NPI | 1669877650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L11048) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 095196) |
| 104100000X Social Worker | |
| 101YM0800X Counselor, Mental Health (Licence: A5114) | |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2026-04-30 |