| NPI | 1083747232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6801016861) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801016861) |
| 106H00000X Marriage & Family Therapist (Licence: MI 6801016861) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2007-07-08 |