| NPI | 1467769406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401000766) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801059719) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2010-09-13 |