| NPI | 1396812525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401001279) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801010401) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2008-04-22 |