| NPI | 1972996924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ID LMSW-29199) |
| 104100000X Social Worker | |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2023-07-31 |