| NPI | 1255874467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL SW12911) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW 12911) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2022-08-11 |