| NPI | 1083760334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 101YM0800X) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OR 104100000X) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-07-08 |