| NPI | 1174035240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 17378) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC 12124) |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2024-10-24 |