| NPI | 1114054780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801065630) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401002813) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2025-03-25 |