| NPI | 1083977169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4101007174) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401013084) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2024-09-11 |