| NPI | 1740014422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2024038586) |
| Enumeration Date | 2024-08-27 |
| Last Update Date | 2025-09-02 |