| NPI | 1770730434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301008881) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: MI 6301008881) |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2017-04-18 |