| NPI | 1952479420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 140) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 001664) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2007-07-08 |