| NPI | 1992428692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 12233) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 7488) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2026-07-21 |