| NPI | 1679692115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0700X Psychologist Adult Development & Aging (Licence: MI 63001000995) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 63001000995) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 63001000995) | |
| 103TF0000X Psychologist Family (Licence: MI 63001000995) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |