| NPI | 1811532898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PR 15940) |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2022-06-09 |