| NPI | 1639253461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6301011290) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301011290) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |