| NPI | 1609860436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801035097) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6401001543) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2010-11-11 |