| NPI | 1720166424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301009486) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801058819) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-03-06 |