| NPI | 1851330864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 069553) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 069553) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2014-01-27 |