| NPI | 1629133616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 31661) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KS 13459) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2025-06-11 |