| NPI | 1033323563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301009090) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301009090) |
| 103TF0200X Psychologist, Forensic (Licence: MI 6301009090) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2012-07-25 |