| NPI | 1437383452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6301009281) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MI 6301009281) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: MI 6301009281) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: MI 6301009281) | |
| 103TR0400X Psychologist Rehabilitation (Licence: MI 6301009281) | |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2009-05-05 |