| NPI | 1275630469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301002813) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6310002813) |
| 103TF0200X Psychologist, Forensic (Licence: MI 6301002813) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-10-29 |