| NPI | 1770826836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IA 007391) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IA 007391) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2024-09-19 |