| NPI | 1881887487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301003882) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301003882) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 6301003882) | |
| 103TF0200X Psychologist Forensic (Licence: MI 6301003882) | |
| 104100000X Social Worker (Licence: MI 6801015946) | |
| 1041C0700X Social Worker Clinical (Licence: MI 6801015946) | |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101005389) | |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2007-08-27 |