| NPI | 1912295742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 991987) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 991987) |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2019-03-04 |