| 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) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 6352000192) | |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2024-07-19 |