| NPI | 1023096872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0404) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM M-1658) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2007-07-08 |