| NPI | 1588684807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 1443-125) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 2195-123) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2008-01-02 |