| NPI | 1184879215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 3074-125) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 5950-120) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2008-11-17 |