| NPI | 1386917821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-10027) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2025-07-11 |