| NPI | 1538048848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL 10623) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL 9686) |
| 1041C0700X Social Worker Clinical (Licence: CO 09930976) | |
| Enumeration Date | 2025-08-29 |
| Last Update Date | 2025-08-29 |