| NPI | 1164502712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IN 39001478A) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301003179) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2010-04-20 |