| NPI | 1225578289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW18536) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL SW18536) |
| 101YP2500X Counselor Professional | |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2024-04-08 |