| NPI | 1407020472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301015335) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC004819) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS017237) | |
| Enumeration Date | 2008-04-21 |
| Last Update Date | 2017-03-17 |