| NPI | 1053872671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401005051) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.0022416) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2019-03-27 |