| NPI | 1770677023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301003103) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801018020) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |