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 |