| NPI | 1316153612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 978) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WV AP00940150) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |