| NPI | 1053475111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 000956) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 002320) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2007-07-08 |