| NPI | 1649404633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 090401648) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2024-06-11 |