| NPI | 1548681489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 97106) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: MD 19215) | |
| Enumeration Date | 2013-12-19 |
| Last Update Date | 2021-12-08 |