| NPI | 1538613948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301016803) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2019-03-13 |