| NPI | 1952468936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 869-125) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 3214) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2010-01-04 |