NPI | 1235228115 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801003212) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005425) |
Enumeration Date | 2006-10-11 |
Last Update Date | 2016-06-13 |