| NPI | 1447864129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801116311) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MI 6801099987) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2024-03-19 |