| NPI | 1568867133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401014451) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 171M00000X Case Manager/Care Coordinator (Licence: MI 6401014451) | |
| Enumeration Date | 2014-10-25 |
| Last Update Date | 2017-12-20 |