| NPI | 1891361507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C016489) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2024-06-19 |