| NPI | 1114509403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2023031675) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2021019915) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2025-04-11 |