| NPI | 1396809794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801012294) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301006566) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2025-09-11 |