NPI | 1356454375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 388-125) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 1863-123) |
Enumeration Date | 2006-08-16 |
Last Update Date | 2007-07-08 |