| NPI | 1144615402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6851100747) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2024-11-05 |