| NPI | 1770473167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 0009926378) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO 0009926378) |
| Enumeration Date | 2025-07-07 |
| Last Update Date | 2025-07-07 |