| NPI | 1689740078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301010405) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301010405) |
| 103TC1900X Psychologist, Counseling (Licence: MI 6301010405) | |
| 104100000X Social Worker (Licence: MI 6301010405) | |
| 1041C0700X Social Worker, Clinical (Licence: MI 6301010405) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-08 |