| NPI | 1780617506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801015156) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005713) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2009-04-22 |