| NPI | 1336187194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 001716) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 000976) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2020-01-07 |