| NPI | 1679026215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| 1041S0200X Social Worker, School | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2021-06-03 |