| NPI | 1538531835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401223149) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6361006822) |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2023-01-25 |