| NPI | 1457469603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301001330) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801018684) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2025-09-11 |