| NPI | 1508359928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 3613-123) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 2-125) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2018-06-11 |