| NPI | 1356312276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301006533) |
| Additional Taxonomies | 103TF0000X Psychologist, Family |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2010-09-24 |