| NPI | 1871137182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 16931) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 011632) |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2022-11-21 |