| NPI | 1386284545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NE 5605) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 5605) |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2022-03-05 |