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Individual

NA DAI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
X

Contact information

Practice address
2700 6TH ST APT 303C, WYANDOTTE, MI 48192-5056
(484) 767-8934
Mailing address
2700 6TH ST APT 303C, WYANDOTTE, MI 48192-5056

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
09/02/2025
Last updated
09/02/2025
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