| NPI | 1861447237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301013186) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 009612) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2007-08-08 |