| NPI | 1487178554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361007971) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6351000431) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2024-01-23 |