| NPI | 1346338357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801084473) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MI 6801084473) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2018-03-06 |