| NPI | 1053094482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P020096) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM SWB-2023-0881) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2024-09-04 |