| NPI | 1790802833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MI 6301007605) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MI 6401007748) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2021-04-27 |