| NPI | 1710025408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801058523) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6801058523) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2013-06-19 |