| NPI | 1295075042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904018256) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-5046) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2013-02-14 |
| Last Update Date | 2025-07-11 |