| NPI | 1578594503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301005159) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301005159) |
| 103TC1900X Psychologist, Counseling (Licence: MI 6301005159) | |
| 103TF0000X Psychologist, Family (Licence: MI 6301005159) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: MI 6301005159) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2009-05-27 |