| NPI | 1104041466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801012171) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005944) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2007-07-08 |