| NPI | 1922124783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361005801) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI C-00735) |
| 101YM0800X Counselor Mental Health (Licence: MI 6401014614) | |
| 101YP2500X Counselor Professional (Licence: MI 6401014614) | |
| 103TC0700X Psychologist Clinical (Licence: MI 6361005801) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2025-04-09 |