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 |