| NPI | 1689749251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801000967) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005065) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-07-08 |