| NPI | 1366724940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301014825) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401012649) |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101006504) | |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2018-10-10 |