| NPI | 1386813061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401004232) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802062829) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2008-02-26 |