| 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 |