| NPI | 1215798616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MT 51529) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MT 51529) |
| Enumeration Date | 2024-01-22 |
| Last Update Date | 2025-06-24 |