| NPI | 1104406271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2022001668) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2019026772) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2022-08-08 |