| NPI | 1821130162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301013601) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301013601) |
| 103TC0700X Psychologist, Clinical (Licence: OR 422) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2008-07-22 |