| NPI | 1427190503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: OH 7723) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301012988) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2023-02-14 |