| NPI | 1265621718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2008034939) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2011-01-10 |