| NPI | 1053645259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361002023) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301014522) | |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2025-03-05 |