| NPI | 1689044570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7580) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C011185) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2026-02-20 |