| NPI | 1790268084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0018138) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2022-03-21 |