| NPI | 1891993135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301003974) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801016813) |
| Enumeration Date | 2007-07-09 |
| Last Update Date | 2007-07-09 |