| NPI | 1811584071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 11947) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 7389) |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2020-12-22 |