| NPI | 1871626614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801060259) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101006085) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |