| NPI | 1508598608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 104100000X Social Worker | |
| 101Y00000X Counselor | |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2022-06-28 |