| NPI | 1902375652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: MI 4101005371) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2018-11-23 |
| Last Update Date | 2018-11-23 |