| NPI | 1053449173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 477125) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 2661123) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2007-07-08 |