| NPI | 1841739133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 21179070632) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301016719) |
| 101Y00000X Counselor (Licence: MI 6401019553) | |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2022-05-26 |