| NPI | 1386638492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-0514) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301007556) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2020-10-13 |