| NPI | 1619475944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM X-11676) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 104100000X Social Worker (Licence: NM M-10625) | |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2021-09-22 |