| NPI | 1265597744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 1243-125) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WI 2564-123) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-07-08 |