| NPI | 1124089099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401009160) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401009160) |
| 103TC1900X Psychologist, Counseling (Licence: MI 6301012786) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301012786) | |
| 103TF0000X Psychologist, Family (Licence: MI 6301012786) | |
| 103T00000X Psychologist (Licence: MI 6301012786) | |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2007-07-08 |