| NPI | 1114083110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 101YS0200X Counselor, School |
| 104100000X Social Worker | |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2025-09-11 |