| NPI | 1770658031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6301005996) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6301005996) |
| 103T00000X Psychologist (Licence: MI 6301005996) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301005996) | |
| 103TC1900X Psychologist, Counseling (Licence: MI 6301005996) | |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2007-07-08 |