| NPI | 1689181869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: CO 206306) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO NLC0106079) |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2018-01-09 |