| NPI | 1801092762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401012311) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802073208) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2016-11-17 |