| NPI | 1821037359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301010097) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 5897985-2501) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2009-07-22 |