| NPI | 1497116164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301009083) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301009083) |
| 103TC1900X Psychologist, Counseling (Licence: MI 6301009083) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301009083) | |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2016-03-09 |