| NPI | 1174905459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008789) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0904008789) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2023-11-16 |