| NPI | 1861503112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401008172) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802061866) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-06-25 |