| NPI | 1922109016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW0001902) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: FL 1902) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2025-08-19 |