| NPI | 1144344417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301009925) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 009925) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2014-07-23 |