| NPI | 1801123096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801086367) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6801086367) |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2009-11-09 |