| NPI | 1366549677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 2-4182) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301004037) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |