| NPI | 1992941280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW21076) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH12228) |
| 101YP2500X Counselor, Professional (Licence: NJ 37PC00888400) | |
| 101YP2500X Counselor, Professional (Licence: NM CTB-2023-0658) | |
| 106H00000X Marriage & Family Therapist (Licence: FL MT4353) | |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2024-08-09 |