| NPI | 1962443275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301011813) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401008151) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2011-04-25 |