| NPI | 1700339298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 130717) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 6032) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2020-04-29 |