| NPI | 1689917932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2023-09-08 |