| NPI | 1669508222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 001636) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MO 002460) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-08 |