| NPI | 1952147670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 12270-125) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 13008-120) |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2026-03-05 |