| NPI | 1831331610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 020267) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 000681) |
| 103T00000X Psychologist (Licence: MI 6301015674) | |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2015-09-23 |