| NPI | 1609102680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361000011) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2021-05-11 |