| NPI | 1992101612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301019447) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSB94024360) |
| 106H00000X Marriage & Family Therapist (Licence: CA 116198) | |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2024-06-27 |