| NPI | 1154320489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 003357) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301003357) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2011-03-08 |