| NPI | 1437196193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301000833) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005074) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2017-12-07 |