| NPI | 1417415621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 11766) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NE 7342) |
| 101YM0800X Counselor, Mental Health (Licence: NE 2815) | |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2023-04-27 |