| NPI | 1023326964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WY 186) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY CAPA-010) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2016-12-14 |