| NPI | 1164091559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-44535) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LMSW-40940) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2026-08-13 |