| NPI | 1871639336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 695) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 2653) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2025-09-11 |