| NPI | 1871316224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6362009926) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6451023628) |
| Enumeration Date | 2024-11-04 |
| Last Update Date | 2024-11-04 |