| NPI | 1154531648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801012831) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005403) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2017-01-05 |