| NPI | 1619020591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301001209) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005418) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2011-10-06 |