| NPI | 1245930528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 6217446-3501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 6217446-3501) |
| 101YP2500X Counselor, Professional (Licence: UT 6217446-3501) | |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-03-06 |