| NPI | 1033768486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 5055) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 1120778) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2025-04-17 |