| NPI | 1700829900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401006358) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401006358) |
| 101YP2500X Counselor, Professional (Licence: MI 6401006358) | |
| 104100000X Social Worker (Licence: MI 6802059251) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-04-24 |