| NPI | 1902192255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401014090) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2014-05-06 |