| NPI | 1497774509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301011634) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401003522) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2008-11-19 |