| NPI | 1124242763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180006020) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E0001970) |
| 104100000X Social Worker (Licence: OH s0006583) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2007-07-08 |