| NPI | 1750853453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L8180) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: TX 60478) | |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2021-08-31 |