| NPI | 1952400848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301005261) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801002112) |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101005829) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2026-04-21 |