| NPI | 1023594652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: MD 28881) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW89587) |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2024-10-07 |