| NPI | 1922313287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301014415) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6301014415) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2015-07-16 |