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 |