| NPI | 1154049062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 132503) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 132503) |
| Enumeration Date | 2022-08-16 |
| Last Update Date | 2024-05-21 |