| NPI | 1033049531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 2383) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 4427) |
| Enumeration Date | 2026-05-19 |
| Last Update Date | 2026-05-19 |