| NPI | 1710752068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH20524) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL MH20524) |
| 1041C0700X Social Worker, Clinical (Licence: FL MH20524) | |
| 171M00000X Case Manager/Care Coordinator (Licence: FL MH20524) | |
| Enumeration Date | 2023-11-16 |
| Last Update Date | 2023-11-16 |