| NPI | 1578765186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6361004145) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 6301008006) |
| 103T00000X Psychologist (Licence: MI 6301008006) | |
| 103TF0000X Psychologist Family (Licence: MI 6301008006) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2024-08-12 |