| NPI | 1356508295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301013341) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: MI 6301013341) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: MI 6301013341) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: MI 6301013341) | |
| 103T00000X Psychologist (Licence: MI 6301013341) | |
| 103TF0000X Psychologist Family (Licence: MI 6301013341) | |
| 103TH0004X Psychologist Health (Licence: MI 6301013341) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: MI 6301013341) | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2012-11-01 |