| NPI | 1083839518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6802083610) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801089154) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2019-07-29 |