| NPI | 1679644355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CO CSW.00000126) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2024-04-30 |