| NPI | 1588757405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 653-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 653125) |
| 101Y00000X Counselor (Licence: WI 10996) | |
| 104100000X Social Worker (Licence: WI 10996-131) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2009-08-31 |