| NPI | 1295935286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801046560) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401000047) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2012-06-26 |