| NPI | 1487792834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361002828) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301010522) |
| 104100000X Social Worker (Licence: MI 6802064603) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-07-01 |