| NPI | 1740326867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301000845) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: MI 6301000845) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-07-08 |