| NPI | 1821159773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801061407) |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101005961) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2025-09-11 |