| NPI | 1356388938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 001669) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist (Licence: MI 000118) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2012-09-12 |