| NPI | 1992170492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL 4848C) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2024-07-30 |