| NPI | 1821325283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301013960) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301013960) |
| 103TF0000X Psychologist, Family (Licence: MI 6301013960) | |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2010-03-23 |