| NPI | 1780005587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301018802) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166.000954) |
| Enumeration Date | 2013-12-20 |
| Last Update Date | 2024-04-03 |