| NPI | 1073660833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 3680) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301007588) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2011-11-02 |