| NPI | 1023176815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC-4819) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LSWI-27227) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2011-07-21 |