| NPI | 1427095918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301064033) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 250229) |
| 101YP2500X Counselor, Professional (Licence: MI 6301013432) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2015-02-13 |