| NPI | 1568585255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301000979) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301000979) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301000979) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301000979) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2009-04-03 |