| NPI | 1285224154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL SW18905) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW18905) |
| 1041C0700X Social Worker, Clinical (Licence: MN 24405) | |
| Enumeration Date | 2021-01-24 |
| Last Update Date | 2024-08-27 |