| NPI | 1619993581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-7671154) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCSW-7671154) |
| 1041C0700X Social Worker, Clinical (Licence: ID LCSW24911) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2025-08-29 |