| NPI | 1649991308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 6131) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NE 2372) |
| Enumeration Date | 2022-09-09 |
| Last Update Date | 2024-05-21 |