NPI | 1306961503 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC004200) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW015535) |
Enumeration Date | 2007-03-20 |
Last Update Date | 2007-07-08 |