| NPI | 1255469573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801008932) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005165) |
| 225C00000X Rehabilitation Counselor (Licence: MI 6801008932) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2008-08-08 |