| NPI | 1871141903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: HI LCSW5148) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: HI LCSW5148) |
| 101YM0800X Counselor Mental Health (Licence: OR L11690) | |
| 1041C0700X Social Worker Clinical (Licence: OR L11690) | |
| Enumeration Date | 2019-09-02 |
| Last Update Date | 2024-03-14 |