| NPI | 1053486142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301005034) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301005034) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MI 6301005034) | |
| 103TF0000X Psychologist, Family (Licence: MI 6301005034) | |
| 103TF0200X Psychologist, Forensic (Licence: MI 6301005034) | |
| 103TF0200X Psychologist, Forensic | |
| 103T00000X Psychologist (Licence: MI 6301005034) | |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2019-12-27 |