| NPI | 1740573104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401002292) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MI 195786) |
| 104100000X Social Worker (Licence: MI 6802070800) | |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2011-05-18 |