| NPI | 1598569246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 14222536-3502) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: ID 4071869) | |
| Enumeration Date | 2025-04-02 |
| Last Update Date | 2025-05-20 |