| NPI | 1003845314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361004091) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301009792) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2022-03-22 |