| NPI | 1255748851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC011443) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301015982) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2020-03-02 |