| NPI | 1790319101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401222657) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301018373) |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2022-08-01 |