| NPI | 1912138835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC1532) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD LC1532) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2023-05-24 |