| NPI | 1942365184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401003793) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005465) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2007-07-08 |