| NPI | 1548879646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: ASW89803) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW89803) |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2024-06-06 |