| NPI | 1245304161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401006597) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301005357) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2015-11-19 |