| NPI | 1114175148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301012482) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: MI 6301012482) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301012482) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2015-08-29 |