| NPI | 1114228384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-4672) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2026-08-13 |