| NPI | 1568918761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904010652) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH I.2507607) |
| 1041C0700X Social Worker, Clinical (Licence: NC P010798) | |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2026-07-27 |