| NPI | 1508956582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4101005291) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301005322) |
| 104100000X Social Worker (Licence: MI 6801021029) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2025-09-11 |