| NPI | 1922880319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2023-10-19 |
| Last Update Date | 2026-06-02 |