| NPI | 1861801367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301010716) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802069405) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2018-01-01 |