| NPI | 1841632361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801067854) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301007535) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2019-11-04 |