| NPI | 1073572541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401009391) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301006182) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2024-03-25 |