| NPI | 1053059170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY004579) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301019073) |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2022-05-27 |