| NPI | 1962559872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: MI 6301005944) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401007956) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2023-11-27 |