| NPI | 1194319418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NE 7574) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 12473) |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2021-02-26 |