| NPI | 1801120407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2026-05-22 |