| NPI | 1447345814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: 00617) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 313129) |
| 171000000X Military Health Care Provider (Licence: 2884paige) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-11-21 |