| NPI | 1114083110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YS0200X Counselor, School |
| Additional Taxonomies | 104100000X Social Worker |
| 1041S0200X Social Worker, School | |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2007-07-08 |