| NPI | 1194883470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 103) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 806) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |