| NPI | 1588986731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6801008979) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801008979) |
| Enumeration Date | 2010-02-15 |
| Last Update Date | 2012-04-24 |