| NPI | 1487733762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 1242308) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 505) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2023-11-14 |