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 |