| NPI | 1780668111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301002279) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY002886) |
| 104100000X Social Worker (Licence: MI 6801012516) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2020-05-06 |