| NPI | 1134229420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 11609) |
| Additional Taxonomies | 104100000X Social Worker (Licence: DE Q3-0000326) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2022-04-19 |