| NPI | 1265631493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401009334) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802074656) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2022-11-25 |