| NPI | 1184789737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6031014166) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MI 4703077967) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2009-05-29 |