| NPI | 1871818377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WV 192) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WV CP00453943) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2010-03-29 |