| NPI | 1992972764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 442-125) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 1265-123) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2008-05-12 |