| NPI | 1710317169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY 823) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TH0100X Psychologist, Health Service (Licence: WY 823) | |
| 104100000X Social Worker (Licence: HI LSW2111) | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical (Licence: CA LCSW88954) | |
| 1041C0700X Social Worker, Clinical (Licence: HI LCSW4133) | |
| Enumeration Date | 2013-11-21 |
| Last Update Date | 2023-06-06 |