| NPI | 1992128318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301019216) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CT 1855) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2024-11-01 |