| NPI | 1376662247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301010580) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301010580) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2019-02-18 |