| NPI | 1164878567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301016659) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6301016659) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2016-05-04 |