| NPI | 1487267852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LMSW-39917) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2025-12-30 |