| NPI | 1437206364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6401004601) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301007352) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2007-07-08 |