| NPI | 1962831206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401008789) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401008789) |
| 251B00000X Case Management (Licence: MI 6401008789) | |
| 251S00000X (Licence: MI 6401008789) | |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2013-11-07 |