| NPI | 1528592938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2018030957) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2021-01-18 |