| NPI | 1073753612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301019358) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MS 48 834) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2025-01-28 |