| NPI | 1609200385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA 30042) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301015413) |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2018-05-08 |