| NPI | 1194752980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401002571) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301011742) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2007-07-08 |