| NPI | 1437324506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 630101063) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801035811) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2009-06-26 |