| NPI | 1295237899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L12739) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LMSW-37446) |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2021-11-17 |