| NPI | 1669415634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA 8520) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801082627) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2023-11-13 |