| NPI | 1831258169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301005356) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: MI 6301005356) |
| 103TC0700X Psychologist Clinical (Licence: MI 6301005356) | |
| 103TC1900X Psychologist Counseling (Licence: MI 6301005356) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: 6301005356) | |
| 103TP0814X Psychologist Psychoanalysis (Licence: MI 6301005356) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: MI 6301005356) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2010-03-25 |