| NPI | 1245754712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CO LSW.0009927088) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor | |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2025-12-29 |