| NPI | 1275736985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 648) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NE 377) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2025-08-31 |