| NPI | 1588851588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301005085) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301005085) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MI 6301005085) | |
| 103TC1900X Psychologist, Counseling (Licence: MI 6301005085) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301005085) | |
| 103TF0000X Psychologist, Family (Licence: MI 6301005085) | |
| 103TF0200X Psychologist, Forensic (Licence: MI 6301005085) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301005085) | |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2007-10-03 |