| NPI | 1538022058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4151001208) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6451024748) |
| Enumeration Date | 2025-12-03 |
| Last Update Date | 2026-05-03 |