| NPI | 1366065393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 5760C) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2024-05-26 |