| NPI | 1922490671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019317) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401014267) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2023-08-30 |