| NPI | 1326155151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401004741) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301009040) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2007-07-08 |