| NPI | 1407424252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 27359) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health (Licence: MD 27359) | |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2025-05-21 |