| NPI | 1194029991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401011875) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401011875) |
| 101YM0800X Counselor Mental Health (Licence: MI 6401011875) | |
| 106H00000X Marriage & Family Therapist (Licence: MI 6401011875) | |
| Enumeration Date | 2011-01-07 |
| Last Update Date | 2015-06-22 |