| NPI | 1184409062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC P019573) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P019573) |
| Enumeration Date | 2023-08-29 |
| Last Update Date | 2025-08-27 |