| NPI | 1962525832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM M1634) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 0295) |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2025-09-11 |