NPI | 1093455750 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6352000192) |
Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: 6352000192) |
Enumeration Date | 2022-03-30 |
Last Update Date | 2025-09-22 |