| 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 |