| NPI | 1508846700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801063517) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101006058) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2023-10-26 |