| NPI | 1710517396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3169) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 20696) |
| 1041C0700X Social Worker, Clinical (Licence: NE 2193) | |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2024-06-12 |