| NPI | 1134259823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6401004942) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301006696) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2025-09-11 |