| NPI | 1396194908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016347) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301016347) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301016347) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MI 6301016347) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301016347) | |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2016-06-06 |