| NPI | 1982029179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301015682) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MI 6301015682) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-09-17 |