| NPI | 1396081451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361007564) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6301015339) |
| 101Y00000X Counselor (Licence: MI 6361007564) | |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2025-02-10 |