| NPI | 1588820005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301007427) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TE1100X Psychologist, Exercise & Sports | |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2008-08-04 |