| NPI | 1730336926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401010619) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401010619) |
| 103T00000X Psychologist (Licence: MI 6361004438) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2024-12-10 |