| NPI | 1396714002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401002170) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MS T0184) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2007-07-08 |