| NPI | 1881947653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801034726) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401000058) |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101005325) | |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2012-10-18 |