| NPI | 1558645267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401000436) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802061913) |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2011-09-30 |