| NPI | 1669031860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301007384) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-06-11 |