| NPI | 1306919717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401000060) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301009063) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801032915) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |