| NPI | 1285735357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401003332) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802035127) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |