| NPI | 1679628283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WV 1757) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WV AP00939551) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2007-07-08 |