| 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 |