| NPI | 1982376448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist | |
| 101Y00000X Counselor | |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2021-10-04 |