| NPI | 1992894992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WV 1704) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WV AP00941076) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2008-02-27 |