| NPI | 1023231339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801034628) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401000057) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |