| NPI | 1669695151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 1075) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WV AP00451622) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |