| NPI | 1679542484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 707) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801012610) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2011-11-22 |