| NPI | 1871564120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401009245) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301006475) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2024-03-12 |