| NPI | 1740387935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301012216) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401009577) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2008-12-05 |