| NPI | 1083968200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 1281-226) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 7196-120) |
| Enumeration Date | 2012-11-09 |
| Last Update Date | 2012-11-09 |