| NPI | 1760280341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LMSW-17689) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ 17689) |
| Enumeration Date | 2025-03-07 |
| Last Update Date | 2025-03-07 |