| NPI | 1295875789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401002173) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301001687) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-08 |