| NPI | 1265081673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LC19278) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ME MC17463) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2021-05-21 |