| NPI | 1306130489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT4659) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401016612) |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101006714) | |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2023-07-10 |