| NPI | 1952137358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301009130) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801034018) |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2024-09-11 |