| NPI | 1154665214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 5165-125) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 542-226) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2022-07-21 |