| NPI | 1609964584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI L698440) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI L925040) |
| 1041C0700X Social Worker, Clinical (Licence: MI L880306) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |