| NPI | 1710126750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301015286) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301015286) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6301015286) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI C-00917) | |
| Enumeration Date | 2009-02-15 |
| Last Update Date | 2016-08-16 |