| NPI | 1922035286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361005620) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301013045) |
| 103TC1900X Psychologist, Counseling (Licence: MI 6301013045) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2022-08-08 |