| NPI | 1548996747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6451023669) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2022-07-29 |
| Last Update Date | 2024-08-08 |