| NPI | 1255066023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: IA 113819) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 113819) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2023-10-13 |