| NPI | 1811139694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCP-3385) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LSW-2401) |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2011-01-12 |