| NPI | 1407150295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301018274) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301017547) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2011-01-07 |
| Last Update Date | 2020-03-11 |