| NPI | 1013562123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 2194C) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL 2194C) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2025-04-24 |