| NPI | 1891820940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801063403) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 002395) |
| 106H00000X Marriage & Family Therapist (Licence: NY 000409) | |
| 106H00000X Marriage & Family Therapist (Licence: CT 000138) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2025-09-11 |