| NPI | 1518690148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC P017869) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: P017869) |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2022-07-01 |