| NPI | 1669511978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401003795) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301008918) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2023-03-13 |