| NPI | 1801954623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401007472) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 6301014127) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2012-10-08 |