| NPI | 1780858498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 1455-125) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 2820-123) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2008-04-17 |