| NPI | 1063081495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019712) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6351004751) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2025-09-04 |