| NPI | 1619112836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6401010969) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MI 6802084115) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2019-02-07 |