| NPI | 1760506679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 4872) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301011252) |
| 103T00000X Psychologist (Licence: NC 4872) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301011252) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 4872) | |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301011252) | |
| 103TF0200X Psychologist, Forensic (Licence: MI 6301011252) | |
| 103TF0200X Psychologist, Forensic (Licence: NC 4872) | |
| 103TH0100X Psychologist, Health Service (Licence: NC 4872) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301011252) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NC 4872) | |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2021-01-20 |