| NPI | 1053468827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401001626) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301013282) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2007-07-09 |