| NPI | 1881291110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 12522) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NE 7594) |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2023-09-27 |