| NPI | 1205174992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI L2184090) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI L2238961) |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2013-01-30 |