| NPI | 1285038521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC7519) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD LGP5936) |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2020-09-28 |