| NPI | 1447502596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401015494) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI L2222073) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2021-02-25 |