| NPI | 1619707932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 14213) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 8129) |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2026-05-10 |