| NPI | 1033207139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401009206) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901011291) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2026-04-16 |