| NPI | 1932390549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 108035) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401010511) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2019-04-01 |