| NPI | 1992452932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361008065) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6362009752) |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2025-06-16 |