NPI | 1306055983 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801000208) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005058) |
Enumeration Date | 2007-05-21 |
Last Update Date | 2010-12-08 |