| NPI | 1093235145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY 785) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301019514) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2025-11-11 |