| NPI | 1669597886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401014572) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6803786341) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2015-04-07 |