| NPI | 1447267299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MO LPC000167) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MO 003564) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2007-07-09 |