| NPI | 1598709172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301008175) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401001324) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-12-27 |