| NPI | 1528461746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301007087) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MI 6301007087) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2014-10-01 |