| NPI | 1780006627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401013958) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101006597) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2016-04-12 |