NPI | 1730202227 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301002671) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101005346) |
Enumeration Date | 2007-04-09 |
Last Update Date | 2007-07-08 |