| NPI | 1740605880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6301015311) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301015311) |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2016-02-05 |