| NPI | 1336167345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801001857) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005859) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |