| NPI | 1417079302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4101005059) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801017511) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2025-09-11 |