| NPI | 1437573672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OK j081668277) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OK j081668277) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2014-02-07 |