| NPI | 1124196985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 33167) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301002325) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2019-08-04 |