| NPI | 1013503275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: ME LM23667) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 010525-01) |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2024-06-21 |