NPI | 1194833533 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301003313) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005272) |
Enumeration Date | 2006-08-27 |
Last Update Date | 2007-07-08 |