| NPI | 1073271151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: WI 20809-875) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MI P0000114) |
| Enumeration Date | 2021-12-06 |
| Last Update Date | 2021-12-06 |