| NPI | 1497907190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401000919) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801016728) |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2016-02-03 |