| NPI | 1831169861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301013084) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MI 6401000662) |
| 103G00000X Clinical Neuropsychologist (Licence: MI 6301013084) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MI 6301013084) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301013084) | |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301013084) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301013084) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MI 6301013084) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301013084) | |
| 103TS0200X Psychologist, School (Licence: IN 725698) | |
| 103TS0200X Psychologist, School (Licence: MI 102165) | |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801058142) | |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101005461) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2021-07-19 |