| NPI | 1174220107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 101Y00000X) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2023-03-22 |