| NPI | 1215203856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6402023330) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802071076) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2017-12-14 |