| NPI | 1679597389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4101005019) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801003812) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2025-09-11 |