| NPI | 1477681229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4101005109) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801010963) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2025-09-11 |