| NPI | 1992042253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-23262) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2025-10-14 |