NPI | 1235385352 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801010527) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005085) |
Enumeration Date | 2008-08-08 |
Last Update Date | 2019-07-08 |