| NPI | 1578600771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301002183) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT27555) |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101005009) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-08 |