| NPI | 1821106675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401007572) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 6301007032) |
| 1041C0700X Social Worker Clinical (Licence: MI 6801066034) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |