| NPI | 1811146764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401000321) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802013020) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2008-09-16 |