| NPI | 1235678053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2022-07-05 |