| NPI | 1114095148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 3300-125) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 3300-125) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2025-09-22 |