| NPI | 1285726513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401008761) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301012481) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2015-10-19 |