| NPI | 1013389360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6801098853) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801098853) |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2017-04-10 |