| NPI | 1740434471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361001384) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6361001384) |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2020-05-13 |