| NPI | 1649711615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 6801100714) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6801100714) |
| 101YP1600X Counselor, Pastoral (Licence: MI 6801100714) | |
| 101YP2500X Counselor, Professional (Licence: MI 6801100714) | |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801100714) | |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2017-03-10 |