| NPI | 1679598379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301007445) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801034293) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-07-08 |