| NPI | 1649617713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6401010580) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MI 6802046755) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2013-05-30 |