| NPI | 1659650638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801017103) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005142) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2011-08-09 |