| NPI | 1508595547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: AR 11813-M) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR 11813-M) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2022-06-06 |