| NPI | 1780768614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361004157) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6361004157) |
| 101YP2500X Counselor, Professional (Licence: MI 6301008502) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2021-04-26 |