| NPI | 1346273802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401008241) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301013077) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2012-10-11 |