| NPI | 1750011441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 4305) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 2592) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2026-03-16 |