| NPI | 1730167172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401005456) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301006559) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2007-07-08 |