| NPI | 1023116324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401012192) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802076772) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-04-18 |