| NPI | 1164546339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: OR 93--0698327) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 93--0698327) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2025-09-11 |