| NPI | 1053428896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401002628) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801060067) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2011-10-30 |