| NPI | 1326387317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301013841) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401009274) |
| Enumeration Date | 2013-02-11 |
| Last Update Date | 2014-05-09 |