| NPI | 1811143357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301011215) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401010626) |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2023-12-08 |