| NPI | 1215003728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 013344) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103T00000X Psychologist (Licence: MI 013344) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2007-07-08 |