| NPI | 1134482573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801066507) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401000525) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2019-01-22 |