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 |