| NPI | 1952723413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical | |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2023-08-07 |