| NPI | 1033169388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6401004594) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401002624) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2007-10-30 |