| NPI | 1912092446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801014689) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801014689) |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101006052) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2017-10-12 |