| NPI | 1003593245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6362009722) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6362009722) |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2023-06-29 |