| NPI | 1851392310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301003782) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005216) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2015-10-28 |