| NPI | 1003283169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401014444) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301016034) |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2019-01-03 |