| NPI | 1033924071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301006483) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301006483) |
| 103T00000X Psychologist | |
| Enumeration Date | 2025-02-07 |
| Last Update Date | 2025-02-07 |