| NPI | 1639462302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 6801083821) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MI 6801083821) |
| 1041C0700X Social Worker Clinical (Licence: MI 6801083821) | |
| Enumeration Date | 2011-05-27 |
| Last Update Date | 2013-04-03 |