| NPI | 1790818839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MI 6301006571) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MI 6301006571) |
| 103TC0700X Psychologist Clinical (Licence: MI 6301006571) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 6301006571) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2013-11-08 |