| NPI | 1427244169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401000497) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401000497) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401000497) | |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2007-09-17 |