| NPI | 1538167218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301002954) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801820618) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2008-12-10 |