| NPI | 1922046770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 2205) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical (Licence: WI 2205) | |
| 101YP2500X Counselor Professional | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2025-10-15 |