| NPI | 1942389481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301008897) |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 103TR0400X Psychologist, Rehabilitation | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2007-07-08 |