| NPI | 1285837815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 4078) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301010842) |
| Enumeration Date | 2007-06-10 |
| Last Update Date | 2007-07-08 |