| NPI | 1386694784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 1622) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 205659) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2007-07-09 |