| NPI | 1952818692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: ID LMSW-37111) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LMSW-37111) |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2025-07-15 |