| NPI | 1649783499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401014910) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401014910) |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101006847) | |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2023-10-10 |