| NPI | 1720541188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2130) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 5224) |
| 1041C0700X Social Worker, Clinical (Licence: NE 10807) | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2022-02-02 |