| NPI | 1306299094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 20354) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 20354) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2025-08-12 |