| NPI | 1912190737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301003778) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2007-08-24 |