| NPI | 1801559661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A17061) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A17061) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2021-11-10 |