| NPI | 1497793111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8151) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301005298) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2015-04-22 |