| NPI | 1952892838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH27926) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL CBHCMS0101215) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2025-07-31 |