| NPI | 1346686961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 1366) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 1366) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2024-10-17 |