| NPI | 1316160419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301012227) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6301012227) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2011-06-13 |