| NPI | 1437738614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801109135) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6801109135) |
| 106H00000X Marriage & Family Therapist (Licence: MI 6801109135) | |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2021-04-06 |