| NPI | 1457545162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401008698) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6361004487) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2022-08-23 |