| NPI | 1003901000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4101006255) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401007374) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2012-06-19 |