| NPI | 1912922410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401008776) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301012496) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2014-02-07 |