| NPI | 1821611518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P014922) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2021-01-27 |