| NPI | 1619565694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 1619565694) |
| Enumeration Date | 2021-01-06 |
| Last Update Date | 2022-02-15 |