| NPI | 1942265012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801019222) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005537) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2007-07-08 |