| NPI | 1992225411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 24759) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD AC2391) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2024-08-13 |