| NPI | 1053410464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WI 2907-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 2907125) |
| 104100000X Social Worker (Licence: WI 16385-130) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2012-05-24 |