| NPI | 1659886232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401016266) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101006752) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2017-12-05 |