| NPI | 1003408501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 10106-125) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 4882-226) |
| 104100000X Social Worker (Licence: WI 10106-25) | |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2025-06-13 |