| NPI | 1689822686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MI 6301013040) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL MH23035) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2024-01-11 |