NPI | 1740494723 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301010389) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401005037) |
Enumeration Date | 2007-05-09 |
Last Update Date | 2014-08-14 |