| NPI | 1801945324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401007864) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801081490) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2007-07-08 |