| NPI | 1053644377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MI 6361002966) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 8952) |
| 101YM0800X Counselor Mental Health (Licence: NE 121) | |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2024-03-06 |