| NPI | 1992357495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2024-07-25 |