| NPI | 1033936208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MI 2653730) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MI SP0000303) |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2024-09-20 |