| NPI | 1588402507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: ID LMSW-43627) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LMSW-43627) |
| Enumeration Date | 2024-07-15 |
| Last Update Date | 2024-08-08 |