| NPI | 1184349797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6362009622) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6451022512) |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2023-11-03 |