| NPI | 1386656023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301006431) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TH0100X Psychologist, Health Service | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301006431) | |
| 103TR0400X Psychologist, Rehabilitation | |
| 261QR1300X Clinic/Center, Rural Health | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2019-08-26 |