| NPI | 1447618160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 74451) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 086996) |
| 101YM0800X Counselor, Mental Health (Licence: GA CSW007172) | |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2026-02-27 |