| NPI | 1902595218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 29806) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| Enumeration Date | 2023-05-03 |
| Last Update Date | 2023-05-23 |