| NPI | 1558683201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301001760) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MI 235724) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2010-02-23 |