| NPI | 1205271822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301015252) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6301015252) |
| 103T00000X Psychologist (Licence: MI 6301015252) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301015252) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301015252) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MI 6301015252) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301015252) | |
| 103TS0200X Psychologist, School (Licence: MI 179302) | |
| 104100000X Social Worker (Licence: MI 6801013804) | |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801013804) | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2013-05-09 |