| NPI | 1134308463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401009133) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2011-04-01 |