| NPI | 1609416197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301019486) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301018243) |
| 103TC1900X Psychologist, Counseling (Licence: MI 6352000108) | |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2025-04-29 |