| NPI | 1932286911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401003279) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301012326) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |